Hypertension

Question 1

Renal causes of secondary hypertension?

Answer 1

Glomerulonephritis
Chronic pyelonephritis
Adult polycystic kidney disease
Renal artery stenosis

Question 2

Endocrine causes of secondary hypertension?

Answer 2

Primary hyperaldosteronism
Phaeochromocytoma
Cushing’s syndrome
Liddle’s syndrome
Congenital adrenal hyperplasia
Acromegaly

Question 3

Other causes of secondary hypertension?

Answer 3

Glucocorticoids
NSAIDs
Pregnancy
Coarctation of the aorta
Combined oral contraceptive pill

Question 4

Recommended investigation for BP?

Answer 4

24 hour BP monitoring:
- ABPM
- HPBM

Question 5

Stage 1 Hypertension values

Answer 5

Clinic BP >140/90
ABPM >135/85

Question 6

Stage 2 Hypertension values

Answer 6

Clinic BP >160/100
ABPM >150/95

Question 7

Severe Hypertension values

Answer 7

Clinic BP >180 systolic or diastolic >110

Question 8

Features suggestive of pheochromocytoma

Answer 8

Labile or postural hypotension
Headache
Palpitations
Pallor
Diaphoresis

Question 9

What happens in ABPM

Answer 9

At least 2 measurements per hour during the person’s usual waking hours
Use the average value of at least 14 measurements

Question 10

What happens in HBPM

Answer 10

Two consecutive BP measurements need to be taken, at least 1 minute apart and with the person seated
BP should be recorded twice daily - morning and evening
BP should be recorded for at least 4 days, ideally for 7 days
Discard the measurements taken on the first day and use the average value of all the remaining measurements

Question 11

Management of stage 1 HTN (>135/85)

Answer 11

Treat if < 80 years of age AND any of the following apply;
- target organ damage
- established cardiovascular disease
- renal disease
- diabetes
- 10-year cardiovascular risk equivalent to 10% or greater

‘consider antihypertensive drug treatment in addition to lifestyle advice for adults aged under 60 with stage 1 hypertension and an estimated 10-year risk below 10%.

Question 12

Management of stage 2 HTN (>150/95)

Answer 12

Offer drug treatment regardless of age

Question 13

Management of severe hypertension (>180/110)

Answer 13

Immediate treatment should be considered
if there are signs of papilloedema or retinal haemorrhages
NICE recommend same day assessment by a specialist
NICE also recommend referral if a phaeochromocytoma is suspected

Question 14

When to treat stage 1 hypertension in those >80

Answer 14

If BP >150/90 offer lifestyle modification and consider drug treatment

Question 15

Do you treat stage 2 hypertension?

Answer 15

Yes

Question 16

At what age do you refer to a specialist?

Answer 16

<40YO

Question 17

How often should BP be monitored?

Answer 17

Annually
At least 5 yearly if not hypertensive but close to 140/90 in clinic

Question 18

Drug management for those <55yo and/or history of diabetes?

Answer 18

Step 1: ACEi/ARB (A)
Step 2: A+C or A+D
Step 3: A+C+D

Question 19

Drug management for those >55yo and/or afro-carribean?

Answer 19

Step 1: CCB
Step 2: C+A or C+D
Step 3: A+C+D

Question 20

When to add low dose spironolactone to management?

Answer 20

Step 4 if K <4.5

Question 21

When to add alpha/beta blocker to management?

Answer 21

Step 4 if K>4.5

Question 22

What to do if on 4 medications and still hypertensive?

Answer 22

Refer to specialist

Question 23

When is it defined as resistant hypertension?

Answer 23

Step 4 requiring a 4th drug

Question 24

BP targets:
- <80YO
- >80YO

Answer 24

<80YO
- <140/90
- <135/85 ABPM

> 80YO
- <150/90 (clinic)
- <145/85 ABPM